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Terms in this set (155)for the nurse, critical thinking provides a framework for reflection on judgements and actions that result in positive outcomes, increasing the accuracy of clinical decisions critical thinking involves the application of knowledge and experience to identify patient problems and to direct, clinical judgements and actions that result in positive patient outcomes clinical reasoning uses critical thinking, knowledge, and experience to develop solutions to problems and make decisions in a clinical setting in nursing education and practice, the term critical thinking is often used synonymously with problem-solving, decision making, reasoning, or judgement problem-solving systematic, analytic approach to finding a solution to a problem decision making choosing a solution or answer from among different options; often considered a step in the problem-solving process reasoning logical thinking that links thoughts, ideas, and facts together in a meaningful way; used in scientific inquiry and problem solving judgement the result or decision related to the process of thinking and reasoning critical thinking is a way to improve the quality of thought process through analysis, assessment, and reconstruction the interaction of these concepts is central to the development of critical thinking -reflection reflection the results of deliberate thinking are used to guide further thinking evidence identification and use of evidence is necessary to guide analysis of situations and decision making standards critical thinking needs to be assessed and evaluated according to standards to ensure quality of thinking attributes or traits
personal characteristics associated with critical thinking, including fairness, responsibility, and empathy, are examples of traits the care the critical thinking model of Alfaro LeFevre has been specifically applied to nursing practice and includes four overlapping and integrated concepts; critical thinking characteristics, theoretical and experimental knowledge, interpersonal skills and technical competencies Alfaro LeFevre model: to develop critical thinking, the nurse needs to develop a critical thinking character, which includes maintaining high standards and developing critical-thinking qualities such as honesty, fair-mindedness, creativity, patience, persistence and confidence the second step in LeFevre's Model in the development of critical thinking includes taking responsibility for personal learning and seeking needed experiences that can provide the necessary knowledge on which to base the thinking the last step in LeFevre's Model is technical competency Starting at the top and going clock-wise around, here's what you need to develop your ability to critically think 1. develop a critical thinking character intellectual standards of critical thinking clarity clarity being easily understood of precise in thought and style; considered a gateway standard because a statement because a statement cannot be evaluated for accuracy or precision if it is ambiguous accuracy representing something in a true and correct way precision
providing sufficient detail to understand exactly what was meant relevance focusing on facts and ideas directly related and pertinent to the topic depth getting beneath the surface of topic or problem to identify and manage related complexities breadth considering a topic, problem, or issue from every relevant viewpoint logic using a mutually supportive and sensible combination of thoughts and facts to form a conclusion significance concentrating on the most important information when considering an issue fairness thinking or acting in accord with reason and without bias baseline knowledge includes content learned in prerequisite courses, nursing-specific courses, and specialty information about specific populations collaboration and delegation - critical thinking guides delegation of tasks inductive reasoning uses specific facts or details to make conclusions and generalizations; it proceeds from specific to general deductive reasoning involves generating facts or details from a major theory, generalization, or premise the terms thinking and reasoning are often used synonymously, although reasoning is more formal because it usually is aimed at finding answers, providing explanations, and forming conclusions nurses use clinical reasoning to monitor patients through ongoing assessment and evaluation and to guide decision making inferences intellectual acts that involve a conclusion being made on the basis of something else intuition the feeling that you know something without specific evidence interpretation -examination of how information is organized and given meaning the accuracy of an inference is directly related to the accuracy on which the inference is based nurses use intuition to facilitate problem solving because their hunches (most likely intuition) is based on experiential knowledge validation the process of gathering information to determine whether the information or data collected
are factual and true subjective data are often validated with objective data; for instance, a patient complains of severe itching, and the nurse validates this subjective finding when observing scratch marks and a rash attitudes necessary for critical thinking confidence make critical thinking essential in nursing the rapid rate of change and increasing complexity of health care and information technology make critical thinking essential in nursing the application of knowledge requires development of a questioning attitude, this process is sometimes, referred to as thinking like a nurse point-of-care testing POCT allows certain laboratory tests to be performed in patient care units standards for POCT include routine assessment of sampling practices, standardized evaluations of controls used in assessing the samples, and review of quality of testing procedure critical thinking in the nursing process interpretation interpretation nurses use this skill to understand and explain meaning of data analysis investigation plans of action on the basis of examination of subjective and objective data is an example evaluation relevance is important in evaluation of new information, also when determining whether the desired outcome for an intervention was achieved critical thinkers skilled in inference make accurate conclusions that are based on sound reasoning explanation the ability to explain conclusions is an important critical-thinking skill self-regulation similar to reflection, self-regulation requires monitoring of thinking, with specific emphasis on reflecting on the rationale for the conclusion drawn and action taken clinical decision making for nurses, the consistent use of the essential skills of critical thinking guides clinical decision making thinking errors to avoid -bias bias a tendency to favoritism or partiality erroneous assumptions -asking questions for clarification before implementing patient care is essential to ensuring patient safety and providing patient-centered care bias may be related to a preconceived notion or prejudice it is important for nurses to examine personal biases because they can negatively impact care often making hasty generalizations and assumptions that do not consider the evidence the illogical thinker may jump to conclusions another trait associated with illogical thinking is an appeal to tradition knowledge deficit (lack of knowledge) is particularly relevant to the increased numbers of medications that nurses administer and the possible interactions with other medications and foods the close-minded nurse may ignore that the individual needs and values of the patient erroneous assumptions can lead to safety issues in the clinical setting it is the nurses responsibility before administering medications to understand the reason that a medication is prescribed, the expected patient response, potential adverse reactions, and drug interactions references are available for point-of-care, hand held devices and in the health care facility electronic health record. if new medication is not references in either of these places, requesting information from the pharmacist is recommended methods for improving critical thinking skills -discussion with colleagues reflection of one's thinking is an important exercise to facilitate critical thinking skills nurses can verify their assessments and diagnoses through discussion with colleagues to enhance clarity, precision, and accuracy the nurse who can recognize and verbalize what is unknown is better equipped to seek what is often a more creative answer or solution strategies that focus on improving critical thinking through written work include reviewing and rewriting study or lecture notes, noting key facts while reading, identifying knowledge gaps while reading, and journaling reflection and critical thinking are essential for providing competent and caring nursing care research indicated that caring encourages nurses to think critically while developing patient-centered plans of care combined competence and caring lead to more positive patient outcomes continuing education, certification, and The Joint Commission- required annual competency reviews are methods used to enhance critical thinking and ensure the competence of licensed nurses basic research research conducted to generate theories, which help provide explanations for phenomena applied research testing the application of theories in different situations with different populations clinical research research used when testing theories about the effectiveness of interventions the ANA standards of professional performance require that use research findings in practice. the criteria measured are twofold - the first criterion is that nurses need to use the best available evidence, which includes research findings, to guide
their practice decisions in 1985, the ANA created the National Center for Nursing Research, which evolved in the Nation Institute of Nursing Research (NINR) in 1993, affording it equal status with other National Institutes of Health - the mission of NINR is to
promote and improve the health of individuals, families, communities, and populations bench-marking you compare yourself against like facilities methods of research gather data, which are information expressed as numbers or words quantitative research usually results in data in the form of numbers qualitative research uses a constructivist philosophy, which assumes that reality is composed of multiple socially constructed realities of each person or group quantitative research uses a post-positivist philosophy, which assumes that reality is objective, fixed, stable, observable, measurable, and value-free positivism assumes that the approach is deductive in nature, and it seeks to gain knowledge through scientific and experimental research phenomenon is an aspect of reality that can be observed or experienced variable is a concept that has different values that can be measured, manipulated, or controlled in the study deductive reasoning takes a large amount of data and formulates a specific concept inductive reasoning
takes a specific concept and tries to generalize descriptive research identifies data and characteristics about the population or phenomenon correlational research explores a relationship between two variables experimental research explores the causal relationships between variables quasi-experimental research examines a causal relationship between variables experimental research examines whether on variable has a cause-and-effect relationship with another, such as blood pressure medication having an effect on decreasing blood pressure quasi-experimental research may not meet the strict guidelines of experimental research phenomenological research explores the experiences of a specific group of people experiencing a similar event in their lives grounded theory research consists of deriving a theory from the data collected in the research ethnography focuses on the sociology of meaning through close field observation of a sociocultural phenomenon historical research studies historic documents to determine an accurate picture of a historical event or time period qualitative research uses a constructvist philosophy, which assumes that reality is composed of multiple socially constructed realities of each person or group, and thus is value laden, focusing on the beliefs, thoughts, and feelings of the person constructivism assumes an approach that is inductive literature review a critical analysis of current information on a specific subject that will be studied in the research systematic review of the literature provides a comprehensive, unbiased analysis through the use of a strict scientific design to select and assess each of the studies a meta-analysis merges statistical results from related studies for the purpose of discovering similarities and differences between the studies hypothesis is a statement about two or more variables and their relationship to each other sample includes the actual individuals in the population from whom the data will be collected instruments are the data collection tools used to collect the information instruments are the data collection tools used to collect the information an example of an instrument is a questionnaire, which may be created either in a Likert scale format, showing the degree of satisfaction with each item, or open-ended questions independent variable a concept that is thought to have an effect on another concept dependent variable the outcome and is affected by the independent variable in experimental research, the independent variable is referred to as an experimental variable or treatment variable control group does not receive the treatment institutional review board a review committee established to help protect the rights and welfare of human research subjects human subject a living subject
about whom an investigator conducting research obtains informed consent begins when subjects are recruited and continues through-out the research process confientiality the assurance that information can be viewed only by those requiring access anonymity means that a person's identity or personal information is not known the vulnerable subjects of research participation include -children important issues in ethical, legal, and professional practice are patient rights regarding informed consent - research participants require an explanation of the study in which they are subjects. data analysis techniques are specific procedures used to summarize the words or numbers and create a meaningful result for interpretation dissemination of outcomes is the communication and distribution of the findings of research application to practice when research is conducted, the goal is to apply the findings to practice patient education and health literacy - patients require that research results be translated into understandable language that is practical for them evidence based practice is an integration of the best available research evidence and the nurse's clinical expertise to make patient care decisions research use the application of research findings to clinical practice EBP results in better patient outcomes, keeps nursing practice current and increases the nurse's confidence in professional decision making assessing the problem - the first phase of EBR consists of assessing the need for change in practice by identifying a problem after identifying the problem, the second phase of EBR consists of formulating a specific research question so that the nurse can effectively search the literature databases one specific method of formulating a research question is identified by the acronym PICO P (patient, population, problem) describe the subject of the problem. the nurse determines how best to describe the group of patients on which the research is to be conducted I (intervention) define which intervention is being considered for the specific patient or population C (comparison intervention) describe a second intervention to compare to the first if appropriate. an example of such a comparison would be a traditional x ray versus an MRI O (outcome) define the type of outcome to assess. outcomes may be of several types. the outcome can relate to changes in a physical sign; the result of a diagnostic test, a patient response to a treatment or intervention, or the cost-effectiveness of a treatment examples of resources for systematic reviews and practice guidelines -systematic reviews critical appraisal is a balanced evaluation of the strengths and benefits as well as the weaknesses and flaws of the research validity generally refers to the strength or the degree to which a concept, conclusion, or measurement is justifiable and corresponds accurately to the real world after identifying an article or systematic review resource that seems appropriate to question, the nurse must critically appraise the information internal validity examination of whether the results of the study are reasonable on the basis of how the study was conducted external validity a measure of whether a study can be applied to any other setting searching for and evaluating evidence internal validity evidence based research example 1. assess the problem nurses should understand that any single means to establishing care, even if it is an accepted method, may not meet the complex needs of individuals patients collaborate with colleagues to use research when caring for the same patient on various shifts and days collaborate with colleagues to used research on the nursing unit to influence the clinical microsystem (the small functional unit where care is provided) educate unlicensed assistive personnel, prior to delegating care, on the importance of EBP for positive patient outcomes collaborate with administrators to use research to influence the larger practice environment function as a participant or co-researcher in a collaborative knowledge-generating research project each of these qualities is present in magnet hospitals - nurses are involved in data collection and decision making in the process of delivering patient care magnet status is an award given by the american nurses credentialing center (ANCC) an affiliate of the ANA a magnet hospital is characterized by excellent patient outcomes resulting from nursing, a high level of nursing job satisfaction with a low nurse turnover rate, and appropriate resolution of any grievance the magnet recognition award supports and evidence-based environment, which includes the nurses' autonomy to improve quality of care by using evidence quality nursing care is the priority of evidence-based practice Sets found in the same folderCh. 2 Alfaro-LeFevre30 terms bekka09 NURSING 115 Final85 terms Dwatkins013 Test 11589 terms kaylakubasek16 Critical Thinking Ch 442 terms Maryalicespaulding8 Other sets by this creatorLSUA HIST 1003 (Rogers) Final Exam90 terms jenna_ard10 integumentary cont11 terms jenna_ard10 Integumentary Health Issues in Children28 terms jenna_ard10 health complications in children141 terms jenna_ard10 Recommended textbook solutionsThe Human Body in Health and Disease7th EditionGary A. 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Why is critical thinking important in evidenceIt engages the skills of analysis and interpretation. The process of CT is oriented toward making judgments about many situations encountered on a daily basis. Critical thinking integrates knowledge and skills. It includes such skills as analysis, evaluation, and inference.
How is critical thinking and EBP related?Used as a component of EBP, critical thinking means the provider should consistently evaluate how much to trust the findings of a given research study. It is important the provider know “the researcher's philosophy of science,” writes Morley D.
What is evidenceWhat Is Evidence-Based Practice? The collection, interpretation, and integration of valid research evidence, combined with clinical expertise and an understanding of patient and family values and preferences to inform clinical decision making.
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